Physician

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The word physician applies to a person who practices some type of medicine. Such practitioners are concerned with maintaining or restoring humanhealth through the study, diagnosis and treatment of disease and injury, through both an area of knowledge — a science — of bodysystems, their diseases and treatment, and the applied practice — an art or craft — of that knowledge.

"The Doctor" by Luke Fildes

Different meanings of the word "physician"

In modern English, the term physician is used in two main ways, with relatively broad and narrow meanings respectively.

This is often confusing, especially to non-physicians. These meanings and variations are listed below.

"Physician" = any medical practitioner

Physician in the broad sense, usually in North America, now applies to any legally qualified practitioner of medicine. In the United States, the term physician is now commonly used to describe any medical doctor holding the Doctor of Medicine (M.D.) or Doctor of Osteopathic Medicine (D.O.) degree (see below). The American Medical Association, established 1847, uses physician in this broad sense to describe all its members. See the article on Medicine for more information on what physicians (in this broad sense) do in practice.

"Physician" = specialist (or subspecialist) in internal medicine

However, Physician is still widely used in an older, narrow sense, especially outside North America. In this usage, a physician is a specialist in internal medicine or one of its many sub-specialties (especially as opposed to a specialist in surgery). This traditional meaning of physician still conveys a sense of expertise in treatment by drugs or medications, rather than by the procedures of surgeons.[1]

This older usage is at least six hundred years old in English; physicians and surgeons were once members of separate professions, and traditionally were rivals. The Shorter OED, third edition, gives a Middle English quotation making this contrast, from as early as 1400: "O Lord, whi is it so greet difference betwixe a cirugian and a physician." [2] Henry VIII granted a charter to the Royal College of Physicians (London) in 1518, and granted the Company of Barber/Surgeons (ancestor of the Royal College of Surgeons) its separate charter in 1540. In the same year, the same English monarch established the Regius Professorship of Physic at Cambridge University [3]. Newer universities would probably describe such an academic as a professor of internal medicine. Hence, in the 16th century, physic meant roughly what internal medicine does now.

These days, a specialist physician in this older, narrow sense would probably be described in the United States as a internist (a specialist in internal medicine). The older, narrow usage of physician (= internist) is common in Britain, Ireland, Canada, Australia, Brazil, New Zealand, Japan, South Africa, India, Indonesia, Republic of China, Pakistan, Bangladesh, Sri Lanka, Zimbabwe and Hong Kong. In such places, the terms doctor or medical practitioner are prevalent, to describe any practitioner of medicine (whom an American would likely call a physician, in the newer, broad sense). For information on the work of specialist physicians in the older, narrow sense, see internal medicine, or else visit the web page are Physicians? at The Royal Australasian College of Physicians — the description given here applies fairly well throughout the Commonwealth of Nations. Note that in Commonwealth countries, specialist paediatricians and geriatricians are also described as specialistphysicians (who have subspecialized by age of patient rather than by organ system).

"Physician and Surgeon"

On both sides of the Atlantic, the combined term Physician and Surgeon is a venerable way to describe either a General Practitioner, or else any medical practitioner irrespective of specialty.[1] This usage still shows the older, narrow meaning of physician and preserves the old difference between a physician, as a practitioner of physic, and a surgeon. The term Physician and Surgeon may be used by state medical boards in the USA, and by equivalent bodies in provinces of Canada, to describe any medical practitioner.

Osteopaths, Chiropractors and Podiatrists

Within the United States, the term physician may also describe Doctors of Osteopathy (D.O.), who are licensed physicians within the USA. However, outside the USA, osteopaths are recognized as complete physicians in only 48 countries. For further information on osteopathy, see the entry on Differences between allopathic and osteopathic medicine.

Those who hold the degrees of Doctor of Chiropractic Medicine (D.C.), Doctor of Naturopathic Medicine (N.D.), or Doctors of Podiatric Medicine (D.P.M.). are physicians according to both the US Federal Government, the Joint Commission (which in 2009 changed its rules to include DC's) and the laws of the vast majority of States. The use of the term "physician" is a legally regulated word, like "university" or "bank", and professional associations do not get to decide who is or is not entitled to use it. Legislatures do.

Like M.D.s or D.O.s, these health care professionals are licensed to diagnose and treat human illnesses. They perform complete physical, orthopedic and neurological examinations, take and interpret their own xrays, and order and interpret laboratory tests, and only then determine if their patient's condition can be resolved within their scope. If not they are trained to refer to another kind of doctor. Despite that they do not prescribe legend drugs, or practice surgery, they have been deemed primary care doctors. Exactly because United States medical boards do not generally give the title Physician and Surgeon, nearly every State now licenses Chiropractic Physicians under their OWN Board. They have served as ringside physicians at boxing meets, and even as Olympic team physicians for both the US and numerous other National Olympic Teams.

Podiatrists perform surgery as well as prescribe legend drugs to their patients.

Social rôle of physicians

Physicians are traditionally considered to be members of a learned profession, because of the extensive training requirements, and also because of the occupation's special ethical and legal duties.

The practice of medicine has ancient associations with religion and magic; see article on History of medicine.

Physicians commonly enjoy high social status, often combined with expectations of a high and stable income. However, medical practitioners often work long and inflexible hours, with shifts at unsociable times, and may earn less than other professionals whose education is of comparable length.

Education and training

Medical training and career pathways vary considerably across the world.

Education of all medical practitioners (physician in the broad sense)

In all developed countries, entry-level medical education programs are tertiary-level courses, undertaken at a medical school attached to a university. Depending on jurisdiction and university, these may be either undergraduate-entry or graduate-entry courses. The former commonly take five or six years. Entrants to graduate-entry courses, usually four or five years, have previously completed a three- or four-year university degree, commonly but by no means always in sciences. Hence, gaining a basic medical degree may take from five to eight or even nine years, depending on jurisdiction and university.

Following completion of entry-level training, newly graduated medical practitioners are often required to undertake a period of supervised practice before full registration is granted, typically one or two years. This may be referred to as "internship" or "conditional registration".

Medical practitioners hold a medical degree specific to the country and sometimes university in which they graduated. This qualifies that doctor to become licensed physicians and surgeons in that country, and sometimes several countries.

Training of specialists in internal medicine (physician in the narrow sense)

After graduation, any medical practitioner may undertake further training in any particular field, to become a medical specialist. This may take from three to six or more years, depending on speciality and jurisdiction. As explained above, a medical practitioner who completes such training in internal medicine (or in one of its subspecialties) is an internist, or a physician in the older, narrow sense.

In some jurisdictions, speciality training is begun immediately following completion of entry-level training, or even before. In other jurisdictions, junior medical doctors must undertake generalist (unstreamed) training for a number of years before commencing specialization. Hence, depending on jurisdiction, a specialist physician (internist) often does not achieve recognition as a specialist until twelve or even more years after commencing basic medical training.

Regulation

In most jurisdictions, physicians (in either sense of the word) need government permission to practice. Such permission is intended (a), to promote public safety, and (b), often to protect the public purse, as medical care is commonly subsidised by national governments.

Regulation of all medical practitioners (physician in the broad sense)

Among the English-speaking countries, this process is known either as licensure as in the United States, or as registration, eg in the United Kingdom, the Commonwealth and Ireland. Synonyms in use elsewhere include colegiación in Spain, ishi menkyo in Japan, autorisasjon in Norway, Approbation in Germany, and "άδεια εργασίας" in Greece. In France, Italy and Portugal, civilian physicians must be a member of the Order of physicians to practice medicine.

In some countries, including the United Kingdom and Ireland, the profession largely regulates itself, with the government affirming the regulating body's authority. The best known example of this is probably the General Medical Council of Britain. In all countries, the regulating authorities will revoke permission to practice in cases of malpractice or serious misconduct.

In the large English-speaking federations (USA, Canada, Australia), the licensing or registration of medical practitioners is done at a state or provincial level. Australian states usually have a "Medical Board," while Canadian provinces usually have a "College of Physicians and Surgeons." All American states have an agency which is usually called the "Medical Board", although there are alternate names such as "Board of Medicine," "Board of Medical Examiners", "Board of Medical Licensure", "Board of Healing Arts", etc. After graduating from medical school, physicians who wish to practice in the USA usually take standardized exams, such as the USMLE for allopathic physicians or COMLEX-USA for osteopathic physicians, which enable them to obtain a certificate to practice from the appropriate state agency.

Regulation of specialists in internal medicine (physician in the narrow sense)

Most countries have some method of officially recognizing specialist qualifications in all branches of medicine, including internal medicine. Sometimes, this aims to promote public safety by restricting the use of hazardous treatments. For example, in Australia, only specialist physicians (internists in USA) or specialist dermatologists may lawfully prescribe istretinoin (this is a powerful drug useful in treating severe acne, but may cause severe and varied types of adverse drug reaction). Other reasons for regulating specialists may include: standardization of recognition for hospital employment, restriction on which practitioners are entitled to receive higher insurance payments for specialist services, and, as occasionally alleged, restriction of specialist numbers to reduce competition.